The 800-pound gorilla about prescription errors

Broken Arrow Family Drug blog

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  • 27 July 2010
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    The 800-pound gorilla about prescription errors

    Last night, a local television station (who “works for YOU!”) presented a story about prescription errors.

    The Executive Director of the Board of Pharmacy does a nice job of giving stock answers about the ‘causes’ of prescription errors – handwriting, transcription problems – but he doesn’t address the 800-pound gorilla in the room. And that’s why you have me.

    I would venture to bet that the majority of prescription errors made by pharmacists are due to volume.

    Like it or not, a pharmacy has to fill a pretty large volume of prescriptions in order to survive. Margins have been getting smaller (insurance companies have to make a profit, too), and pharmacies have had to cut back on staffing in order to even maintain their same profit levels.

    Fewer staff = more prescriptions per person = more chances for mistakes.

    Our buddies at Wal-Mart haven’t helped matters with their $4 program. Yes, I know that people LOVE the program. Consider the consequences, though. How many of those $4 prescriptions does a pharmacist have to fill in order to turn a profit? Wal-Mart has made it clear that prescriptions are now a commodity at their store (like bread and milk), and that pharmacists are not professionals, but a legally-required part of a fulfillment process – like assembly line workers. I can assure you – if they could find a way to fill prescriptions without an expensive pharmacist, they would do it.

    So why didn’t the news station point out the obvious? Because they’re busy promoting the hype of ‘low prices’. Either they’re not smart enough or unwilling to recognize the connection between the competitive pressures of lowering prices and increases in the possibility of errors. It’s much more exciting for the station to say, “Look, we investigated and saved you money!”, than it is to say, “Look, we sent you to an error-prone pharmacy! Hope you get better soon!”

    The chains will point to automation as a factor that decreases errors. Automation doesn’t solve everything. There are some software programs that allow prescriptions to be sent electronically directly to the pharmacy’s prescription processing computer. The majority of prescriptions, though, are either handed to the patient, faxed to the pharmacy, or called to the pharmacy. As long as you have humans involved in ANY aspect of filling, mistakes can happen.

    So how do you decrease the likelihood of an error?

    First, know your pharmacist. Yeah, I know, I keep harping on this. Well, think about it. How can you assess whether the person behind the counter has the aptitude to fill your prescription properly if you’ve never even talked to him? Yes, I know he has to pass Board exams and get his license from the state. That’s no guarantee that he can construct a coherent sentence, or hasn’t taken the last 20 years off. Trust me, there’s some of them out there.

    Second, know the pharmacy staff. If you see different personnel every time you’re in the store, something’s wrong. Either the work environment stinks or they don’t pay very well. Either one is a sign that the store management/ownership is cutting corners. And having fewer, less-experienced personnel is a bad thing for you.

    Third, ask questions before you leave the pharmacy. Know what you’re supposed to be taking and why. And if the pharmacist is too busy to come out and answer your question, then the pharmacy is not properly staffed.

    Fourth, have patience. A properly-staffed pharmacy will generally have your prescription ready in 15 minutes or less. Be aware, though, that if there’s a problem, you’re going to get to wait a little longer. You should be more worried that the pharmacist gets it RIGHT than whether Billy makes it to his t-ball game on time.

    Fifth, if your doctor insists on writing his prescriptions by hand, make sure that YOU can read it before leaving – especially the drug name. If you can’t read it, we may not be able to, either.

    Lastly, trust your gut. If something sounds wrong, ask again.

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